Sex Differences in the Association Between Regular Physical Activity and Incident Atrial Fibrillation: A Meta‐analysis of 13 Prospective Studies

Zhu, Wenzhen; Wan, Rong; Din, Ying; Xu, Zhenyan; Yang, Xiongwen; Hong, Kui

doi:10.1002/clc.22531

Cited by 30 publications

(24 citation statements)

References 38 publications

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“…Long‐term vigorous physical training is associated with an increased risk of AF in athletes, but this association does not exist in nonathletes . Interestingly, there is a sex difference in the aforementioned association; in brief, an increased level of physical activity is most likely associated with an increased risk of AF in men and a reduction of AF incidence in women . These inconsistent results may be due to the imprecision of physical activity assessment via self‐reported rather than direct measurement.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Interestingly, there is a sex difference in the aforementioned association; in brief, an increased level of physical activity is most likely associated with an increased risk of AF in men and a reduction of AF incidence in women. 26 These inconsistent results may be due to the imprecision of physical activity assessment via self-reported rather than direct measurement. Although physical-activity habits are considered the main determinant of physical fitness, 27 we should not equate physical fitness with habitual physical activity.…”

Section: Discussionmentioning

confidence: 99%

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Association of Physical Fitness With the Risk of Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Zhu

Shen²,

Zhou

et al. 2016

Clinical Cardiology

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Several studies have investigated the role of physical fitness in atrial fibrillation (AF), but the results remain controversial. We aimed to estimate the association between physical fitness and risk of AF. We comprehensively retrieved data from the Cochrane Library, PubMed, and Embase databases until February 29, 2016, for studies evaluating the association of physical fitness with the risk of AF. Data were abstracted from included studies, and effect estimates were pooled using a random-effects model. Six studies with a total of 205 094 participants and 15 919 AF cases fulfilled the inclusion criteria. When physical fitness was assessed as a continuous variable, per incremental increase of physical fitness was associated with a 9% reduced risk of AF (risk ratio [RR]: 0.91, 95% confidence interval [CI]: 0.84-1.00, P = 0.05). When physical fitness was assessed as a categorical variable, the risk of AF was significantly reduced (RR: 0.51, 95% CI: 0.28-0.91, P = 0.02) in individuals with the highest level of physical fitness compared with those with the lowest level. The intermediate vs the lowest level of physical fitness was associated with a 28% reduced risk of AF (RR: 0.72, 95% CI: 0.56-0.93, P = 0.01). The sensitivity analysis indicated that these results were stable. Notably, there was evidence of statistical heterogeneity across studies; therefore, we should interpret the results cautiously. In conclusion, published literature supports that a higher level of physical fitness is associated with a lower risk of AF. Further studies should be performed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Physical Fitness With the Risk of Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Zhu

Shen²,

Zhou

et al. 2016

Clinical Cardiology

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“…In women, moderate exercise has been reported to be associated with a reduced risk of AF. 18 A recent meta-analysis reported that moderate-intensity exercise was associated with a 9% and 19% risk reduction of AF in women and men, respectively, in comparison with sedentary individuals. 19 Men who performed intense exercise had a 3-fold increased risk of AF in comparison with sedentary individuals, whereas women performing vigorous exercise had a 28% reduction in incident AF.…”

Section: Risk Factorsmentioning

confidence: 99%

Atrial Fibrillation and Ventricular Arrhythmias

Gillis

2017

Circulation

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ABSRACT: Sex-specific differences in the epidemiology, pathophysiology, clinical presentation, clinical treatment, and clinical outcomes of atrial fibrillation (AF), sustained ventricular arrhythmias, and sudden cardiac death are recognized. Sex hormones cause differences in cardiac electrophysiological parameters between men and women that may affect the risk for arrhythmias. The incidence and prevalence of AF is lower in women than in men. However, because women live longer and AF prevalence increases with age, the absolute number of women with AF exceeds that of men. Women with AF are more symptomatic, present with more atypical symptoms, and report worse quality of life in comparison with men. Female sex is an independent risk factor for death or stroke attributable to AF. Oral anticoagulation therapy for stroke prevention has similar efficacy for men and women, but older women treated with warfarin have a higher residual risk of stroke in comparison with men. Women with AF are less likely to receive rhythm control antiarrhythmic drug therapy, electric cardioversion, or catheter ablation in comparison with men. The incidence and prevalence of sustained ventricular arrhythmias and sudden cardiac death are lower in women than in men. Women receiving implantable cardioverter defibrillators for primary prevention of sudden cardiac death are less likely to experience sustained ventricular arrhythmias in comparison with men. In contrast, women receiving a cardiac resynchronization therapy implantable cardioverter defibrillator for the treatment of heart failure are more likely to benefit than men. Women are less likely to be referred for implantable cardioverter defibrillator therapy despite current guideline recommendations. Women are more likely to experience a significant complication related to implantable cardioverter defibrillator implantation in comparison with men. Whether sex differences in treatment decisions reflect patient preferences or treatment biases requires further study.

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“…Overall, there is inadequate evidence to reliably affirm a proarrhythmogenic effect for exercise in women. 43 It is likely that sex physiological differences, attenuated exercise-induced cardiac remodelling, or a lower exercise intensity in women than in men could also contribute to the lack of an evident exercise-induced increased risk of AF. 44 The risk of AF conferred by exercise progressively increases with the intensity of exercise ( Figure 2B).…”

Section: [H2] Exercise-induced Afmentioning

confidence: 99%

Diagnosis, pathophysiology, and management of exercise-induced arrhythmias

Guasch

Mont

2016

Nat Rev Cardiol

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The cardiovascular benefits of physical activity are indisputable. Nevertheless, growing evidence suggests that both atrial fibrillation and right ventricular arrhythmia can be caused by intense exercise in some individuals. Exercise-induced atrial fibrillation is most commonly diagnosed in middle-aged, otherwise healthy men who have been engaged in endurance training for >10 years, and is mediated by atrial dilatation, parasympathetic enhancement, and possibly atrial fibrosis. Cardiac ablation is evolving as a first-line tool for athletes with exercise-induced arrhythmia who are eager to remain active. The relationship between physical activity and right ventricular arrhythmia is complex and involves genetic and physical factors that, in a few athletes, eventually lead to right ventricular dilatation, followed by subsequent myocardial fibrosis and lethal ventricular arrhythmias. Sinus bradycardia and atrioventricular conduction blocks are common in athletes, most of whom remain asymptomatic, although incomplete reversibility has been shown after exercise cessation. In this Review, we summarize the evidence supporting the existence of exercise-induced arrhythmias and discuss the specific considerations for the clinical management of these patients.

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Sex Differences in the Association Between Regular Physical Activity and Incident Atrial Fibrillation: A Meta‐analysis of 13 Prospective Studies

Cited by 30 publications

References 38 publications

Association of Physical Fitness With the Risk of Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Association of Physical Fitness With the Risk of Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Atrial Fibrillation and Ventricular Arrhythmias

Diagnosis, pathophysiology, and management of exercise-induced arrhythmias

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